PART E: SHAREHOLDERS ID Type Nationality

Transcription

1 AOPR/ APPLICATION FOR REGISTRATION AS A CROSS BORDER ROAD TRANSPORT OPERATOR PART A: APPLICATION TYPE New Deregistration Amendment PART B: OPERATOR PARTICULARS Name of Organisation/Person: Type of Organisation: Public Company Partnership Trust Co-Operative Private Company Sole-Proprietor Non-Profit Other Business Registration or No.: Tax Reference No: Date of Registration: PART C: HEAD OFFICE PARTICULARS Preferred Physical Postal Physical Code: Postal Code: Cell: PART D: PROXY PARTICULARS Full names: Gender: Male Female Date of Birth: D D / M M / Y Y Y Y Country of Origin: Name Shareholder Name Shareholder type: Driving Licence Other: number: Expiry Date: D D / M M / Y Y Y Y Country of Issue: type: number: Cell: Surname Surname Date of Birth Date of Birth PART E: SHAREHOLDERS Type Nationality Other: Specify If additional shareholders provide list PART F: DIRECTORS Type Nationality Other: Specify If additional directors provide list Number Number Country of Issue Country of Issue

2 PART G: EXPERIENCE Date from Date to No Passengers / Tons of Goods per month Client Name Of Depot: Physical PART H: DETAILS OF DEPOTS/OPERATING CENTRES DEPOT 1 Postal Telephone No.: Name: Name Of Depot: Physical MAINTENANCE PROVER PARKING PREMISES (IF NOT AT DEPOT) DEPOT 2 Postal Post Code: Telephone No.: Name: Name Of Depot: Physical MAINTENANCE PROVER PARKING PREMISES (IF NOT AT DEPOT) DEPOT 3 Postal Post Code: Telephone No.: Name: MAINTENANCE PROVER PARKING PREMISES (IF NOT AT DEPOT) Post Code:

3 PART K: SUPPORTING DOCUMENTS Tick if Applicable Documents Tax clearance certificates Company registration documents Shareholder certificates Company Profile Proof of public liability insurance PART L: REFUSAL / REVOCATION Has the Applicant ever had an Operating License refused or revoked? Yes No If yes provide details Authority Date Refuse/Revoke Reason PART M: DECLARATION I hereby 1. Declare that I have the authority to submit this application 2. declare that all the particulars furnished by me in this form are true and correct; and

4 FLE/ DEPOT FLEET MAINTENANCE PART A: DEPOT PARTICULARS PART B: RCP PARTICULARS PART C: PARTICULARS OF VEHICLES # VIN No. Registration Cross Dangerous Add/Remove from Make Model Insurer Value Insured No. Border Goods Fleet 1. Yes No Yes No Add Remove 2. Yes No Yes No Add Remove 3. Yes No Yes No Add Remove 4. Yes No Yes No Add Remove 5. Yes No Yes No Add Remove 6. Yes No Yes No Add Remove 7. Yes No Yes No Add Remove 8. Yes No Yes No Add Remove 9. Yes No Yes No Add Remove 10. Yes No Yes No Add Remove 11. Yes No Yes No Add Remove 12. Yes No Yes No Add Remove 13. Yes No Yes No Add Remove 14. Yes No Yes No Add Remove 15. Yes No Yes No Add Remove PART D: SUPPORTING DOCUMENTS 1. Certified copies of the registration documents of all vehicles that needs to be added to the Depot s Fleet must be attached to this application. 2. If the Operator is not the owner of the vehicle a copy of the lease agreement must be attached. PART E: DECLARATION I, the RCP of the Depot whose details appear above, hereby

5 DRV/ DEPOT DRIVER MAINTENANCE PART A: DEPOT PARTICULARS PART B: RCP PARTICULARS PART C: PARTICULARS OF DRIVERS # Name Surname Nationality Type No. Country of Issue Date Add/Remove from Employed Driver List 1. Add Remove 2. Add Remove 3. Add Remove 4. Add Remove 5. Add Remove 6. Add Remove 7. Add Remove 8. Add Remove 9. Add Remove 10. Add Remove 11. Add Remove 12. Add Remove 13. Add Remove 14. Add Remove 15. Add Remove PART D: SUPPORTING DOCUMENTS Certified copies of the driving licences of all drivers that needs to be added to the Depot s Driver List must be attached to this application. PART E: DECLARATION I, the RCP of the Depot whose details appear above, hereby

6 ARCP/ APPLICATION FOR REGISTRATION AS RESPONSIBLE COMPETENT PERSON MULTILATERAL CROSS-BORDER ROAD TRANSPORT AGREEMENT Full names: Gender: Male Female PART A: PARTICULARS OF APPLICANT Date of Birth: D D / M M / Y Y Y Y Country of Origin: type: Driving Licence Other number: Expiry Date: D D / M M / Y Y Y Y Country of Issue: Preferred Physical Postal Permanent Physical Postal Code: Code: Permanent Village Traditional Authority District Tel (home): Cell: PART B: QUALIFICATION Tel (work): Qualification Degree Diploma Certificate Institution Date (Attach proof of qualification)

7 PART C: EXPERIENCE IN TRANSPORT Date From Date To Goods Passengers Dangerous Abnormal Organisation Details Position No of Vehicles in Fleet Name Current Telephone No. Name Telephone No. Name Telephone No. PART D: DRIVING LICENSES License Code License Number Date of 1 st Issue Expiry Date Issued By PART E : PROFESIONAL DRIVING PERMITS Type License Number Date of 1 st Issue Expiry Date Issued By Goods Passengers Dangerous PART F : SUPPORTING DOCUMENTS Tick if Applicable Documents Identification (National,, Voter card or Driving License) Proof of address Driving licence Medical Certificate clearing him/her to drive Police clearance certificate Set of fingerprints recorded by police Two passport style photographs Proof of training Proof of qualification Reference letter from Employer (at least one) PART G: DECLARATION I declare that the above particulars are true and correct and realise that a false declaration is punishable by a fine or imprisonment or both. Signature of applicant : Place: Date: D D / M M / Y Y Y Y

8 ORA/ AGREEMENT BETWEEN OPERATOR AND RCP Operator No.: Name of Operator: PART A: OPERATOR PARTICULARS PART B: DEPOT PARTICULARS PART C: RCP PARTICULARS PART D: AGREEMENT Please indicate if RCP should be added or removed from the Operator. Add Responsible Competent Person Remove Responsible Competent Person It is hereby recorded that a contract of service is: It is hereby recorded that a contract of service is: REGISTERED SUSPENDED between the abovementioned Operator and the Responsible Competent Person in relation to the depot/operating centre referred to in this application. It is hereby agreed between the parties that the RCP holder is authorised to perform the functions necessary to control the quality of the transport operations in his area of responsibility. PART E: OPERATOR DECLARATION I, the Proxy of the Operator whose details appear above, hereby PART F: RCP DECLARATION I, the PCR whose details appear above, hereby

9 ANOM/ NOMINATION OF DRIVER OR PERSON IN CONTROL Operator No.: Name of Operator: Transgression No.: Transgression Date: Vehicle No.: Vehicle Make: Vehicle Model: Driver No.: PART A: OPERATOR PARTICULARS PART B: DEPOT PARTICULARS PART C: RCP PARTICULARS PART D: TRANSGRESSION PARTICULARS PART E: DECLARATION I, the RCP of the Depot whose details appear above, hereby 1. declare that the driver whose details appear above was driving/responsible for the vehicle at the time of the offence. 2. declare that I have the authority to submit this application; 3. declare that all the particulars furnished by me on this form are true and correct; and 4. realise that a false declaration is punishable with a fine or imprisonment or both.

10 ADGO/ APPLICATION FOR REGISTRATION AS A DANGEROUS GOODS OPERATOR Operator No.: Name of Operator: Please attach the following supporting documents: PART A: OPERATOR PARTICULARS PART B: DEPOT PARTICULARS PART C: RCP PARTICULARS PART D: SUPPORTING DOCUMENTS Certificate issued by independent auditor proving competence and compliance. PART E: DECLARATION I, the RCP of the Depot whose details appear above, hereby Tick if attached

11 AAL/ APPLICATION FOR ABNORMAL LOAD PERMIT Operator No.: Name of Operator: Vehicle No.: Registration Number: Make: Model: Date of Travel: Origin: Transit: Transit: Transit: Transit: PART A: OPERATOR PARTICULARS PART B: DEPOT PARTICULARS PART C: RCP PARTICULARS PART D: VEHICLE PARTICULARS PART E: ROUTE PARTICULARS City / Town Country Destination: Weight: kg PART F: LOAD PARTICULARS Dimensions: L: m W: m H: m PART G: DECLARATION I, the RCP of the Depot whose details appear above, hereby